Regional Field Activities

Regional Conferences on Emerging Diseases

Regional Training Projects

REGIONAL FIELD ACTIVITIES

1. Pilot Project for Control of Avian Influenza in Tangerang Indonesia

The Pilot Project for Control of Avian Influenza (AI) in Tangerang Municipality and District in Indonesia is supported through a trilateral agreement of the Governments of Indonesia, Singapore and the United States. The Indonesian government chose Tangerang  for the pilot project in 2005 because the first human cases of avian influenza in Indonesia occurred in Tangerang, and because there have been extensive outbreaks of AI at domestic and commercial poultry farms in Tangerang since 2004.   Nineteen human cases of AI have been reported in Tangerang since June 2005.

REDI Center is partnering with the Indonesian Ministries of Health and Agriculture, the Singapore MOH, WHO, FAO, USAID, USDA (APHIS), and US CDC to assist the local animal and human health authorities for the implementation of the Pilot Project.  The long-range goal of the project is to establish the necessary capacity for effective human and animal surveillance and control of AI.   REDI Center received grants from the US Department of Health and Human Services and from the US Department of Agriculture to support the Tangerang Pilot Project. In June 2007 REDI Center signed a Memorandum of Understanding (MOU) with the Directorate General of Communicable Disease Control and Environmental Health of the Ministry of Health, which provides the basic framework for engagement of REDI Center in the project.

The Pilot Project Secretariat, which is supported by REDI Center, has conducted extensive education of the community’s poultry producers, human health and agricultural officials. The general objective was to increase AI awareness, e.g. modes of transmission and means of infection control in poultry and reduction of poultry-to-human transmission. The Pilot Project Team headed by Dr. Gindo Simanjuntak and Dr. M. Sudomo have completed a survey of villagers’ knowledge, attitudes and practices (KAP) that affect transmission of AI. The Secretariat also conducted a GIS (Geographic Information System) survey that allows mapping the poultry production facilities in the Municipality and studying its correlation with AI outbreaks in humans and poultry.  Data from the KAP and GIS surveys will be used as a baseline to evaluate the progresses in controlling AI in poultry and in reducing the human exposure to the virus.   If successful, the project will serve as a model for the AI control in Indonesia and in the region.

 

REDI Center in partnership with the Jakarta Office of WHO is supporting the Directorate of Medical Services (DMS) of the Indonesian MOH to strengthen and improve the medical management of AI through train-the -trainer workshops for staff from 100 designated referral hospitals for care and treatment of AI patients.  This project is supported by a grant from the US Department of Health and Human Services.   REDI Center signed a Memorandum of Understanding with the DMS of the Indonesian MOH in April 2008 that provides a framework for this collaborative training project. 
The DMS specifies that each AI referral hospital must have a medical team with capability for diagnosis, care and management of AI cases with severe pneumonia and for following strict infection control guidelines.  Each hospital team has medical specialists in critical care, infectious diseases, pulmonology, pediatrics, and  critical care nurses.  Trainers for the course are Indonesian experts on clinical and laboratory diagnosis of Avian Influenza, anti-viral treatment, critical pulmonary care, and hospital infection control procedures.  For practical and logistical reasons the training workshops were held at 4 regional venues:   1) for central and western Java on 23-26 July 2007 in Bandung, 2) for eastern Java, Sulawesi, Kalimantan, Nussa Tanggara Barrat and Timor on 26-29 August 2007 in Surabaya, 3) for Sumatra and Riau on 2-5 March 2008 in Batam, and 4) for hospitals that were unable to attend previous workshops  on  9-10 June 2008 in Jakarta.

In follow-up to these training workshops, REDI Center and WHO are assisting Indonesian experts to assess the clinical data from AI patients treated since 2005.  This information and the lessons learned will be used to update the Indonesian National Guidelines for Care and Treatment of AI Patients and for updating the training materials.  In addition selected staff from the leading AI referral hospitals will receive advanced training for clinical management of acute respiratory distress syndrome (ARDS) and septic shock at the Medical Intensive Care Unit of Hospital Cochin at Cochin University in Paris, France.

3. Seroprevalence and Incidence of H5N1 Among Poultry Workers, Poultry and the Environment in Tangerang

REDI Center with grant support from the US CDC is helping to train trainers to teach hospital infection control in Vietnam, Laos, Cambodia and Indonesia.   A five day workshop for 100 hospital infection control trainers from the targeted countries was held in Singapore in November of 2006.  Infection control experts from the Singapore MOH, Singapore General Hospital, National University Hospital and Tan Tock Seng Hospital lectured on the principles and practices for infection control in health care settings and led practical exercises on the use of personal protective equipment and implementation of best infection control practices for managing patients infected with avian influenza.   
 
From discussions with infection control experts in the region, REDI Center learned that better designed and easy-to-use teaching modules were urgently needed to improve the effectiveness of infection control training for health care workers in the region.  In response, REDI Center is partnering with the Southeast Asia Regional Office of WHO and US CDC to develop state-of- the art training modules for infection control of AI and TB in health care settings.  After reaching consensus on basic training objectives with the collaborating partners, REDI Center contracted with the JH Piego Company to draft the training modules, that cover the principles and regulations for infection control, case studies and practical exercises.   To evaluate the training materials, the modules were presented at a September 2008 Workshop in Bangkok to infection control experts from 12 countries who critiqued the educational approaches and the accuracy, content and effectiveness of the materials.  Recommendations of the regional experts have been incorporated into the final version of the training package.  This unique learning resource package will soon be available on this web site, and will be accessible for translation into local languages and adapted to infection control policies by countries in the Southeast Asia and Western Pacific regions.  REDI Center will be assisting regional countries to adapt and implement infection control training programs and to evaluate the impact of the training on knowledge and practices for AI infection control in referral hospitals.